Dynamics of skin microbiota in shoulder surgery infections

Abstract

Post-surgical infections arise due to various contributing factors. Most important is the presence of potential pathogenic microorganisms in the skin complemented by the patient´s health status. Cutibacterium acnes is commonly present in the pilosebaceous glands and hair follicle funnels in human skin. After surgical intervention, these highly prevalent, slow-growing bacteria can be found in the deeper tissues and in proximity of implants. C. acnes is frequently implicated in post-surgical infections, often resulting in the need for revision surgery. This review summarizes the current understanding of microbial dynamics in shoulder surgical infections. In particular, we shed light on the contribution of C. acnes to post-surgical shoulder infections as well as their colonization and immune-modulatory potential. Despite being persistently found in post-surgical tissues, C. acnes is often underestimated as a causative organism due to its slow growth and the inefficient detection methods. We discuss the role of the skin environment constituted by microbial composition and host cellular status in influencing C. acnes recolonization potential. Future mapping of the individual skin microbiome in shoulder surgery patients using advanced molecular methods would be a useful approach for determining the risk of post-operative infections.

Two are better than one: increased biofilm formation in dual-type compared to single-type communities of Cutibacterium acnes

“…Cutibacterium acnes is a common human skin bacterium with proposed bene cial roles for human health. However, recent ndings suggest that it is also a frequent cause of OIAIs associated with shoulder arthroplasties [24,25]. Some studies have found evidence for polymicrobial OIAIs involving C. acnes, but also monomicrobial OIAIs with multiple C. acnes strains belonging to different phylotypes (i.e.…”

Human skin microbiota in health and disease

“…at bay [46]. C. acnes ’ dominance within hair follicles further influences on the risk of postoperational infections as they are not eradicated by normal pre‐operational preparations [47] (Table 1).…”

“…The inner volume of the terminal hair follicle is thereby 10 times that of vellus hair follicle. Corresponding to the higher prevalence of terminal hair follicles, men have an increased risk of deep tissue postoperational infections [47]. Considerable bacterial aggregates are found within hair follicles in particular in moist and sebaceous skin habitats [45,49,51] and, accordingly, serve as potential reservoir of the skin microbiota [30,54].…”

Bacterial micro-aggregates as inoculum in animal models of implant-associated infections

“…Biofilms are recalcitrant toward the immune system and antimicrobials [ 11 ] due to a combination of factors such as the protective matrix covering the aggregates [ 12 , 13 ], the size of the aggregates [ 14 , 15 ], the metabolically inactive state of the bacteria [ 16 , 17 ], and their differentiation into distinct phenotypes inside the aggregates [ 14 , 18 , 19 ]. Studies have shown that skin surface aggregates can persist even after surgical preparation and disinfection of the skin [ 20 , 21 ] and that the average diameter of aggregates on the skin surface is 5–15 μm in diameter, whereas aggregates located in hair follicles are larger with an average size of 50 μm in diameter [ 9 ].…”